key: cord-0795149-lp31l8y3
authors: Murphy, Kevin R.; Patel, Niraj C.; Ein, Daniel; Hudelson, Mary; Kodoth, Sangeetha; Marshall, Gailen D.; Parikh, Purvi; Blaiss, Michael S.
title: Insights from American College of Allergy, Asthma, and Immunology COVID-19 Vaccine Task Force: Allergic Reactions to mRNA SARS-CoV-2 Vaccines: Allergic Reactions to mRNA SARS-CoV-2 Vaccines
date: 2021-01-23
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2021.01.017
sha: d4ea9f6a9940438c41f56915c5edbd1538cd4edc
doc_id: 795149
cord_uid: lp31l8y3

nan

In those at higher-risk for developing serious or fatal COVID-19 infections, and who have 38 previously experienced a suspected or confirmed severe allergic reaction to a CoV-2 vaccine or 39 any of its components, a graded vaccine administration protocol could provide an option for 40 administration. Guidance for the graded administration of a vaccine has previously been 41 published: administer 0.05 mL 1:10 dilution, 10%, 20%, 30%, and 40% of the full dose 42 incrementally in alternate arms at 15-minute intervals, followed by a minimum 30-minute 43 observation period (5) . Presently there are not yet data to confirm efficacy and safety of this 44 approach, as is commonly performed with other vaccines. Until such data is available, graded 45 vaccine administration should be considered experimental and is not endorsed by the ACAAI. 46

The ACAAI COVID-19 Vaccine Task Force has provided guidance for physicians and other 48 providers related to risk of an allergic reaction (COVID-19). We recommend that all patients 49 should be screened by asking several questions to determine possible risk for an allergic reaction 50 to the mRNA COVID-19 vaccines. (Table 1 .) An affirmative response to any of these questions 51 should prompt a referral to a board-certified allergist/immunologist for further evaluation prior to 52

CoV-2 vaccination. The guidance underscores that a history of food, venom, inhalant, latex, or 53 medication allergy should not preclude patients from receiving the vaccine. All patients should 54 have direct observation/waiting time of 15 minutes after vaccination, except for those with a 55

history of systemic reactions to food, drugs, or venoms, who should wait 30 minutes. All 56 facilities administering the vaccine must be prepared to treat anaphylaxis. Caution should be 57 exercised in patients with mast cell activation disorders/idiopathic anaphylaxis, as risk in this 58 group is not known. 59

Thus, the evaluation of at-risk patients should be individualized. As part of that evaluation, one 60 should employ shared decision-making surrounding the approach to testing and future 61 vaccination. It is vital that patients understand the overall benefit of vaccination against CoV-2 62 virus in relationship to the extremely low overall risk of an allergic reaction. 63

Allergists/Immunologists are uniquely qualified to guide their patients and educate the public 64 during this extensive vaccine campaign and assist in bringing this pandemic to an end by 65 achieving adequate herd immunity. 66 Table 1 Screening Questions*

Risk of anaphylaxis after vaccination in children and adults

Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine in the United States from

CDC 12/30/2020: Interim Clinical Considerations for Use of mRNA COVID-19

Vaccines Currently Authorized in the United States

mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Approach

Adverse reactions to vaccines practice parameter 2012 update

Do you have a history of a severe allergic reaction to an injectable medication (intravenous, intramuscular

Do you have a history of a severe allergic reaction to a prior vaccine? 3. Do you have a history of a severe allergic reaction to polyethylene glycol (PEG), a polysorbate or polyoxyl 35 castor oil (e.g., paclitaxel) containing injectable or vaccine?